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1.  Correlates of Human Papillomavirus Vaccination Rates in Low-Income, Minority Adolescents: A Multicenter Study 
Journal of Women's Health  2012;21(8):813-820.
Low rates of human papillomavirus (HPV) vaccination in low-income, minority adolescents may exacerbate racial disparities in cervical cancer incidence.
Using electronic medical record data and chart abstraction, we examined correlates of HPV vaccine series initiation and completion among 7702 low-income and minority adolescents aged 11–21 receiving primary care at one of seven medical centers between May 1, 2007, and June 30, 2009. Our population included 61% African Americans, 13% Caucasians, 15% Latinas, and 11% other races; 90% receive public insurance (e.g., Medicaid). We used logistic regression to estimate the associations between vaccine initiation and completion and age, race/ethnicity, number of contacts with the healthcare system, provider documentation, and clinical site of care.
Of the 41% of adolescent girls who initiated HPV vaccination, 20% completed the series. A higher proportion of girls aged 11–<13 (46%) and 13–<18 (47%) initiated vaccination than those aged 18–21 (28%). In adjusted analyses, receipt of other recommended adolescent vaccines was associated with vaccine initiation, and increased contact with the medical system was associated with both initiation and completion of the series. Conversely, provider failure to document risky health behaviors predicted nonvaccination. Manual review of a subset of unvaccinated patients' charts revealed no documentation of vaccine discussions in 67% of cases.
Fewer than half of low-income and minority adolescents receiving health maintenance services initiated HPV vaccination, and only 20% completed the series. Provider failure to discuss vaccination with their patients appears to be an important contributor to nonvaccination. Future research should focus on improving both initiation and completion of HPV vaccination in high-risk adolescents.
PMCID: PMC3411349  PMID: 22860770
2.  Distributed Health Outcome Monitoring and Evaluation Using i2b2  
There is a pressing need for better tools to support comparative effectiveness research (CER) on a national scale. In addition, little is known about within-class outcome disparities for commonly used cardiovascular and diabetes medications. In this presentation, we will describe our experience implementing a new i2b2 cell, the Health Outcome Monitoring and Evaluation Cell (HOME), at 5 collaborating Clinical Translational Science Award sites (CTSAs) in the U.S. We will also describe the motivations to developing a common query framework, and findings related to the implementation and use of the HOME cell, to perform distributed CER queries. Our focus is on the assessment of race, gender, and location-based disparities in outcomes for patients treated with similar mediations for hypertension, dyslipidemias, and diabetes.
PMCID: PMC3845782  PMID: 24303227
3.  Enabling Hierarchical View of RxNorm with NDF-RT Drug Classes 
NDF-RT is the proposed source of drug classification information. We set out to construct a hierarchy of NDF-RT drug classes and RxNorm medications and evaluate it on medication records data. NDF-RT and RxNorm are distributed in different file formats, require different tools to manipulate and linking the two into a hierarchy is a non-trivial exercise. Medication data in RxNorm from two institutions was constrained by the hierarchy. Only 37% of records from one and 65% from another institution were accessible. We subsequently enriched the RxNorm mapping in NDF-RT by exploiting relationships between concepts for branded and generic drugs. Coverage improved dramatically to 93% for both institutions. To improve usability of the resulting hierarchy, we grouped clinical drugs by corresponding clinical drug form.
PMCID: PMC3041416  PMID: 21347044
4.  Quality indicators and quality assessment in child health 
Archives of disease in childhood  2009;94(6):458-463.
Quality indicators are systematically developed statements that can be used to assess the appropriateness of specific healthcare decisions, services and outcomes. In this review, we highlight the range and type of indicators that have been developed for children in the UK and US by prominent governmental agencies and private organizations. We also classify these indicators in an effort to identify areas of child health that may lack quality measurement activity. We review the current state of health information technology in both countries since these systems are vital to quality efforts. Finally, we propose several recommendations to advance the quality indicator development agenda for children. The convergence of quality measurement and indicator development, a growing scientific evidence base and integrated information systems in healthcare may lead to substantial improvements for child health in the 21st century.
PMCID: PMC2774840  PMID: 19307196
Quality; Quality indicators; General pediatrics; Health information technology
5.  BostonBreathes: Improving pediatric asthma care with a home-based interactive website for patient education, monitoring, and clinical teamwork 
The BostonBreathes (BB) system is an interactive website enabling physician-physician and physician-patient communication, monitoring (peak-flow, medication use, symptoms) of asthma patients in the home, and patient and family asthma education. The system helps primary care physicians to function in team relationships with asthma specialists and nurses. Patients and families can interact with their health professionals online as members of the care team. BB uniquely combines patient education, monitoring, and clinical teamwork functions into one integrated web environment.
PMCID: PMC1839731  PMID: 17238763
7.  TLC-Asthma: An Integrated Information System for Patient-centered Monitoring, Case Management, and Point-of-Care Decision Support 
A great deal of successful work has been done in the area of EMR development, implementation, and evaluation. Less work has been done in the area of automated systems for patients. Efforts to link data at multiple levels – the patient, the case manager, and the clinician have been rudimentary to-date.
In this paper we present a model information system that integrates patient health information across multiple domains to support the monitoring and care of children with persistent asthma. The system has been developed for use in a multi-specialty group practice and includes three primary components: 1) a patient-centered telephone-linked communication system; 2) a web-based alert reporting and nurse case-management system; and 3) EMR-based provider communication to support clinical decision making at the point-of-care.
The system offers a model for a new level of connectivity for health information that supports customized monitoring, IT-enabled nurse case-managers, and the delivery of longitudinal data to clinicians to support the care of children with persistent asthma.
Systems like the one described are well -suited, perhaps essential, technologies for the care of children and adults with chronic conditions such as asthma.
PMCID: PMC1480156  PMID: 14728122

Results 1-8 (8)